Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Geriatrics
Published in: BMC Geriatrics 1/2022

Open Access 01-12-2022 | Research

Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older

Authors: Emma Bajeux, Lilian Alix, Lucie Cornée, Camille Barbazan, Marion Mercerolle, Jennifer Howlett, Vincent Cruveilhier, Charlotte Liné-Iehl, Bérangère Cador, Patrick Jego, Vincent Gicquel, François-Xavier Schweyer, Vanessa Marie, Stéphanie Hamonic, Jean-Michel Josselin, Dominique Somme, Benoit Hue

Published in: BMC Geriatrics | Issue 1/2022

Login to get access

Abstract

Background

Older patients often experience adverse drug events (ADEs) after discharge that may lead to unplanned readmission. Medication Reconciliation (MR) reduces medication errors that lead to ADEs, but results on healthcare utilization are still controversial. This study aimed to assess the effect of MR at discharge (MRd) provided to patients aged over 65 on their unplanned rehospitalization within 30 days and on both patients’ experience of discharge and their knowledge of their medication.

Methods

An observational multicenter prospective study was conducted in 5 hospitals in Brittany, France.

Results

Patients who received both MR on admission (MRa) and MRd did not have significantly fewer deaths, unplanned rehospitalizations and/or emergency visits related to ADEs (OR = 1.6 [0.7 to 3.6]) or whatever the cause (p = 0.960) 30 days after discharge than patients receiving MRa alone. However, patients receiving both MRa and MRd were more likely to feel that their discharge from the hospital was well organized (p = 0.003) and reported more frequently that their community pharmacist received information about their hospital stay (p = 0.036).

Conclusions

This study found no effect of MRd on healthcare utilization 30 days after discharge in patients over 65, but the process improved patients’ experiences of care continuity. Further studies are needed to better understand this positive impact on their drug care pathway in order to improve patients’ ownership of their drugs, which is still insufficient. Improving both the interview step between pharmacist and patient before discharge and the transmission of information from the hospital to primary care professionals is needed to enhance MR effectiveness.

Trial registration

NCT04018781 July 15, 2019.
Appendix
Available only for authorised users
Footnotes
1
CONPARMED study on “Guaranteeing the continuity of the medical care pathway of the older patient: a territorial approach to clinical pharmacy” (“Garantir la CONtinuité du PARcours de soins MEDicamenteux du patient âgé: une approche territoriale de pharmacie clinique” in French).
 
2
Called Soins de Suite et de Réadaptation (SSR) in French.
 
Literature
1.
Beijer HJM, de Blaey CJ. Hospitalisations caused by adverse drug reactions (ADR): a meta-analysis of observational studies. Pharm World Sci. 2002;24(2):46–54.PubMedCrossRef
2.
El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA, Karapinar-Çarkit F. Prevalence and Preventability of Drug-Related Hospital Readmissions: A Systematic Review. J Am Geriatr Soc. 2018;66(3):602–8.PubMedCrossRef
3.
Schwab C, Korb-Savoldelli V, Escudie JB, Fernandez C, Durieux P, Saint-Jean O, et al. Iatrogenic risk factors associated with hospital readmission of elderly patients: A matched case-control study using a clinical data warehouse. J Clin Pharm Ther. 2018;43(3):393–400.PubMedCrossRef
4.
Roughead EE, Semple SJ, Rosenfeld E. The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. Int J Evid Based Healthc. 2016;14(3):113–22.PubMedCrossRef
5.
Rottenkolber D, Hasford J, Stausberg J. Costs of adverse drug events in German hospitals–a microcosting study. Value Health J Int Soc Pharmacoeconomics Outcomes Res. 2012;15(6):868–75.CrossRef
6.
Forster AJ, Clark HD, Menard A, Dupuis N, Chernish R, Chandok N, et al. Adverse events among medical patients after discharge from hospital. CMAJ Can Med Assoc J J Assoc Medicale Can. 2004;170(3):345–9.
7.
Davies EC, Green CF, Mottram DR, Rowe PH, Pirmohamed M. Emergency re-admissions to hospital due to adverse drug reactions within 1 year of the index admission. Br J Clin Pharmacol. 2010;70(5):749–55.PubMedPubMedCentralCrossRef
8.
Ruiz B, García M, Aguirre U, Aguirre C. Factors predicting hospital readmissions related to adverse drug reactions. Eur J Clin Pharmacol. 2008;64(7):715–22.PubMedCrossRef
9.
10.
Koronkowski MJ, Semla TP, Schmader KE, Hanlon JT. Recent Literature Update on Medication Risk in Older Adults, 2015–2016. J Am Geriatr Soc. 2017;65(7):1401–5.PubMedPubMedCentralCrossRef
11.
Harris CM, Sridharan A, Landis R, Howell E, Wright S. What happens to the medication regimens of older adults during and after an acute hospitalization? J Patient Saf. 2013;9(3):150–3.PubMedCrossRef
12.
13.
Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565–71.PubMedCrossRef
14.
Chiewchantanakit D, Meakchai A, Pituchaturont N, Dilokthornsakul P, Dhippayom T. The effectiveness of medication reconciliation to prevent medication error: A systematic review and meta-analysis. Res Soc Adm Pharm RSAP. 2020;16(7):886–94.CrossRef
15.
Mekonnen AB, McLachlan AJ, E Brien J anne. Effectiveness of pharmacist-led medication reconciliation programmes on clinical outcomes at hospital transitions: a systematic review and meta-analysis. BMJ Open. 2016;6(2):e010003.PubMedPubMedCentralCrossRef
16.
Daliri S, Boujarfi S, El Mokaddam A, Scholte Op Reimer WJM, Ter Riet G, den Haan C, et al. Medication-related interventions delivered both in hospital and following discharge: a systematic review and meta-analysis. BMJ Qual Saf. 2020;30(2):146–56.PubMedCrossRef
17.
Renaudin P, Boyer L, Esteve MA, Bertault-Peres P, Auquier P, Honore S. Do pharmacist-led medication reviews in hospitals help reduce hospital readmissions? A systematic review and meta-analysis: Pharmacist-led medication reviews and hospital readmissions. Br J Clin Pharmacol. 2016;82(6):1660–73.PubMedPubMedCentralCrossRef
18.
Cheema E, Alhomoud FK, Kinsara ASAD, Alsiddik J, Barnawi MH, Al-Muwallad MA, et al. The impact of pharmacists-led medicines reconciliation on healthcare outcomes in secondary care: A systematic review and meta-analysis of randomized controlled trials. PLoS ONE. 2018;13(3): e0193510.PubMedPubMedCentralCrossRef
19.
Redmond P, Grimes TC, McDonnell R, Boland F, Hughes C, Fahey T. Impact of medication reconciliation for improving transitions of care. Cochrane Database Syst Rev. 2018;8:CD010791.PubMed
20.
Kwan JL, Lo L, Sampson M, Shojania KG. Medication Reconciliation During Transitions of Care as a Patient Safety Strategy: A Systematic Review. Ann Intern Med. 2013;158(5_Part_2):397.PubMedCrossRef
21.
Guisado-Gil AB, Mejías-Trueba M, Alfaro-Lara ER, Sánchez-Hidalgo M, Ramírez-Duque N, Santos-Rubio MD. Impact of medication reconciliation on health outcomes: An overview of systematic reviews. Res Soc Adm Pharm RSAP. 2020;16(8):995–1002.CrossRef
22.
Anderson LJ, Schnipper JL, Nuckols TK, Shane R, Le MM, Robbins K, et al. Effect of medication reconciliation interventions on outcomes: A systematic overview of systematic reviews. Am J Health Syst Pharm. 2019;76(24):2028–40.PubMedPubMedCentralCrossRef
23.
Dawoud DM, Smyth M, Ashe J, Strong T, Wonderling D, Hill J, et al. Effectiveness and cost effectiveness of pharmacist input at the ward level: a systematic review and meta-analysis. Res Soc Adm Pharm. 2019;15(10):1212–22.CrossRef
24.
Al-Hashar A, Al-Zakwani I, Eriksson T, Sarakbi A, Al-Zadjali B, Al Mubaihsi S, et al. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. Int J Clin Pharm. 2018;40(5):1154–64.PubMedCrossRef
25.
Chiarelli MT, Antoniazzi S, Cortesi L, Pasina L, Novella A, Venturini F, et al. Pharmacist-driven medication recognition/ reconciliation in older medical patients. Eur J Intern Med. 2021;83:39–44.PubMedCrossRef
26.
Gillespie U, Alassaad A, Henrohn D, Garmo H, Hammarlund-Udenaes M, Toss H, et al. A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older: a randomized controlled trial. Arch Intern Med. 2009;169(9):894–900.PubMedCrossRef
27.
Bonnet-Zamponi D, d’Arailh L, Konrat C, Delpierre S, Lieberherr D, Lemaire A, et al. Drug-Related Readmissions to Medical Units of Older Adults Discharged from Acute Geriatric Units: Results of the Optimization of Medication in AGEd Multicenter Randomized Controlled Trial. J Am Geriatr Soc. 2013;61(1):113–21.PubMedCrossRef
28.
Tomlinson J, Cheong VL, Fylan B, Silcock J, Smith H, Karban K, et al. Successful care transitions for older people: a systematic review and meta-analysis of the effects of interventions that support medication continuity. Age Ageing. 2020;49(4):558–69.PubMedPubMedCentralCrossRef
29.
Eggink RN, Lenderink AW, Widdershoven JWMG, van den Bemt PMLA. The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci PWS. 2010;32(6):759–66.PubMedCrossRef
30.
31.
Singh D, Fahim G, Ghin HL, Mathis S. Effects of Pharmacist-Conducted Medication Reconciliation at Discharge on 30-Day Readmission Rates of Patients With Chronic Obstructive Pulmonary Disease. J Pharm Pract. 2021;34(3):354–9.PubMedCrossRef
32.
Nickerson D, Smith N, Hunter P. New developments in a strongly coupled cardiac electromechanical model. Eur Eur Pacing Arrhythm Card Electrophysiol J Work Groups Card Pacing Arrhythm Card Cell Electrophysiol Eur Soc Cardiol. 2005;7(Suppl 2):118–27.
33.
Ford I, Norrie J. Pragmatic Trials. Drazen JM, Harrington DP, McMurray JJV, Ware JH, Woodcock J, editors. N Engl J Med. 2016 Aug 4;375(5):454–63.
34.
Barnish MS, Turner S. The value of pragmatic and observational studies in health care and public health. Pragmatic Obs Res. 2017;8:49–55.CrossRef
35.
Ware JH, Hamel MB. Pragmatic Trials — Guides to Better Patient Care? N Engl J Med. 2011;364(18):1685–7.PubMedCrossRef
36.
37.
Alix L, Bajeux E, Hubert J, Cador B, Josselin JM, Tuffier S, et al. Medication reconciliation in hospital patients over the age of 65: How long does it take and how much does it cost? A time-motion study in an internal medicine ward. Eur J Intern Med. 2020;73:100–2.PubMedCrossRef
38.
39.
40.
Nebeker JR, Barach P, Samore MH. Clarifying adverse drug events: a clinician’s guide to terminology, documentation, and reporting. Ann Intern Med. 2004;140(10):795–801.PubMedCrossRef
41.
O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing. 2014;44(2):213–8.PubMedPubMedCentralCrossRef
42.
Gusmano M, Rodwin V, Weisz D, Cottenet J, Quantin C. Comparison of rehospitalization rates in France and the United States. J Health Serv Res Policy. 2015;20(1):18–25.PubMedCrossRef
43.
Urban R, Armitage G, Morgan J, Marshall K, Blenkinsopp A, Scally A. Custom and practice: A multi-center study of medicines reconciliation following admission in four acute hospitals in the UK. Res Soc Adm Pharm. 2014;10(2):355–68.CrossRef
44.
Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, et al. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178–87.PubMedPubMedCentralCrossRef
45.
Fernandes BD, Almeida PHRF, Foppa AA, Sousa CT, Ayres LR, Chemello C. Pharmacist-led medication reconciliation at patient discharge: A scoping review. Res Soc Adm Pharm. 2020;16(5):605–13.CrossRef
46.
Lindquist LA, Go L, Fleisher J, Jain N, Baker D. Improvements in Cognition Following Hospital Discharge of Community Dwelling Seniors. J Gen Intern Med. 2011;26(7):765–70.PubMedPubMedCentralCrossRef
47.
Phatak A, Prusi R, Ward B, Hansen LO, Williams MV, Vetter E, et al. Impact of pharmacist involvement in the transitional care of high-risk patients through medication reconciliation, medication education, and postdischarge call-backs (IPITCH Study). J Hosp Med. 2016;11(1):39–44.PubMedCrossRef
48.
Flanagan P, Kainth S, Nissen L. Satisfaction survey for a medication management program: satisfaction guaranteed? Can J Hosp Pharm. 2013;66(6):355–60.PubMedPubMedCentral
49.
Karapinar-Çarkıt F, Borgsteede SD, Janssen MJA, Mak M, Yildirim N, Siegert CEH, et al. The effect of a pharmaceutical transitional care program on rehospitalisations in internal medicine patients: an interrupted-time-series study. BMC Health Serv Res. 2019;19(1):717–29.PubMedPubMedCentralCrossRef
50.
Pellegrin KL, Krenk L, Oakes SJ, Ciarleglio A, Lynn J, McInnis T, et al. Reductions in Medication-Related Hospitalizations in Older Adults with Medication Management by Hospital and Community Pharmacists: A Quasi-Experimental Study. J Am Geriatr Soc. 2017;65(1):212–9.PubMedCrossRef
51.
Coleman EA, Smith JD, Frank JC, Min SJ, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc. 2004;52(11):1817–25.PubMedCrossRef
52.
Vervloet M, van Dijk L, Rademakers JJDJM, Bouvy ML, De Smet PAGM, Philbert D, et al. Recognizing and Addressing Limited PHarmaceutical literacy: Development of the RALPH interview guide. Res Soc Adm Pharm RSAP. 2018;14(9):805–11.CrossRef
53.
Bajeux E, Corvol A, Somme D. Integrated Care for Older People in France in 2020: Findings, Challenges, and Prospects. Int J Integr Care. 2021;21(4):16.PubMedPubMedCentralCrossRef
54.
Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;11(337): a2390.CrossRef
55.
Loudon K, Treweek S, Sullivan F, Donnan P, Thorpe KE, Zwarenstein M. The PRECIS-2 tool: designing trials that are fit for purpose. BMJ. 2015;8(350): h2147.CrossRef
Metadata
Title
Pharmacist-led medication reconciliation at patient discharge: a tool to reduce healthcare utilization? an observational study in patients 65 years or older
Authors
Emma Bajeux
Lilian Alix
Lucie Cornée
Camille Barbazan
Marion Mercerolle
Jennifer Howlett
Vincent Cruveilhier
Charlotte Liné-Iehl
Bérangère Cador
Patrick Jego
Vincent Gicquel
François-Xavier Schweyer
Vanessa Marie
Stéphanie Hamonic
Jean-Michel Josselin
Dominique Somme
Benoit Hue
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2022
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-022-03192-3

Other articles of this Issue 1/2022

BMC Geriatrics 1/2022 Go to the issue

Research

Frailty and functional dependence in older population: lessons from the FREEDOM Limousin – Nouvelle Aquitaine Cohort Study

Research

Associations of multicomponent exercise and aspects of physical performance with frailty trajectory in older adults

Research

Associations among health-promoting lifestyle, self-care agency and health-related quality of life in Bai older adults with hypertension in Yunnan China

Research

Differences in clinical features and mortality in very old unvaccinated patients (≥ 80 years) hospitalized with COVID-19 during the first and successive waves from the multicenter SEMI-COVID-19 Registry (Spain)

Research article

Efficacy and evaluation of therapeutic exercises on adults with Parkinson’s disease: a systematic review and network meta-analysis

Research

Individual and environmental factors associated with cognitive function in older people: a longitudinal multilevel analysis
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits